Chest Pain Guide
Chest Pain Clinics
|What Is Chest Pain?
Chest pain is an umbrella term to describe any pain or discomfort in the chest area (image of chest area). It may feel dull or sharp, last a few seconds to a few hours, occur in one spot or spread across the width of the body and down the arms. The pain can be in the skin covering the chest, in the muscles, ribcage or in an organ housed in the area such as the heart or lungs. While chest pain is associated with heart attacks and other dangerous conditions, it is mostly caused by minor disorders such as indigestion or muscle strain. Every year about 200,000 cases of chest pain, not related to coronary heart disease (CHD), are reported in America.
Studies show that where chest pain is caused by coronary heart disease in women, it is much more likely to be dismissed as nothing serious by doctors, than when it occurs in men. This is partly due to the myth that heart disease is a man’s problem and partly due to the fact that women often experience milder chest pain than men when having a heart attack. Although larger medical centers are beginning to recognize these differences, it still important for women themselves to be aware of the signs of coronary heart disease and seek proper medical advice when concerned. Heart disease testing is usually sufficient for identifying the cause of cardiac (heart) related chest pain. Non-cardiac causes can be more difficult to identify and may require blood tests, scans and X-rays to bring about a diagnosis.
What Are The Symptoms?
Symptoms of chest pain: Anyone who experiences severe chest pain will no doubt feel very frightened because of its association with heart attacks. Chest pain is not a condition but rather a symptom of a condition. It is a term to describe any pain, pressure, squeezing or constriction in the chest region. Pain which radiates to the jaw, head or arm should be considered a medical emergency. If you experience a heavy squeezing pain which spans the width of the chest and lasts more than 20 minutes, also seek immediate treatment. You may be having a heart attack. Chest pain accompanied by fever may be pneumonia. Pain related to eating food or certain types of food may be due to acid reflux. Any chest pain which is relieved by lying down is not usually a sign of heart disease. A patient with recurrent chest pain which occurs with physical activity and disappears with rest may be having angina attacks. If the chest is tender to touch, without swelling, it may just be a pulled muscle. If there is swelling it may be a sign of inflammation which usually improves on its own after a few weeks.
When Is Chest Pain Not a Heart Attack?
1. When pain is sharp, brief and stabbing and only lasts a few seconds.
2. Pain that comes and goes regularly cannot be a heart attack. However it may be a symptom of angina (chest pain caused by narrowed arteries).
3. Pain that lasts for hours. Chest pain associated with heart attacks usually only lasts for 20 to 30 minutes.
4. Pain that becomes worse with movement is probably related to muscle soreness or damaged bones - not the heart.
5. If you are worried about heart problems, read about heart attack symptoms and know your risk factors for heart disease.
What Are The Causes?
Generally most causes of chest pain fall into 2 categories: heart related and non-heart related.
Heart related causes include:
1. CHD and angina pectoris (the most common type of angina).
2. Onset of a heart attack (image).
3. Stroke in women (it is a less common sign of stroke in men).
4. Heart valve disorders such as aortic stenosis.
5. Pericarditis, inflammation of the sac surrounding the heart tissue.
6. Coronary artery spasm.
Non-heart related causes include:
1. Pneumonia and pleurisy of the lungs.
2. Muscle strain due to exercise.
3. Costochondritis - an inflammation in the area between the ribs and the cartilage that holds them to the breastbone. It is commonly experienced by women with fibromyalgia (see, fibromyalgia guide).
4. Fractured or broken ribs.
5. Osteoporosis of the spine can cause pain similar to angina.
6. Heartburn, more technically known as GERD.
7. Esophageal motility disorders, a common cause of chest pain which is aggravated by abnormalities in the passage of food to the stomach.
8. Irritable bowel syndrome.
9. Emotional anxiety or stress.
10. Gallbladder disease.
11. Peptic ulcers developing in the stomach.
12. Chest pain and heart palpitations can sometimes be a symptom of menopause.
13. Shingles, which most commonly occurs in people over the age of 50.
14. Side effects from medications such as tamoxifen used for treating breast cancer.
15. Symptom of cancer, for example indicating a recurrence of cervical cancer.
How Is It Diagnosed?
Diagnosis of chest pain: Despite the advancements in modern technology, a thorough physical examination and taking the patient's medical history remains the most important part of diagnosing the cause of chest pain. The doctor will want to know about the characteristics of the pain, where it is located, how long it lasts, whether it radiates to other parts of the body and if the patient has any other symptoms such as nausea or breathlessness. The source of the pain may still be difficult to diagnose because angina pain can easily be confused with indigestion pain, and chest tightening associated with heart attacks could also be due to stress. Women in particular have to be extra vigilant about ensuring they receive a thorough clinical evaluation because statistics show that doctors are less likely to send them for heart tests such as echocardiogram (image) or electrocardiogram (EKG) as men. Where people are admitted to emergency for chest pain, if heart attack is ruled out, studies show that in 42 percent end up having gastroesophageal disorders such as ulcers, acid reflux, esophageal perforation. Another 28 percent are likely to have a musculoskeletal problem such as rib fractures or muscle strain.
At The Doctors
As doctor visits can be quite brief, it is worth organizing your thoughts and concerns before your visit. You may find the PACE prompter useful:
P: Provide information about how you feel.
A: Ask questions if you do not understand.
C: Clarify what you hear.
E: Express any concerns or worries you may have.
Questions to Ask
Note your answers to the following questions and give them to your doctor at the start of the consultancy:
1. How are you feeling generally?
2. Where in your chest is the pain?
3. Is the pain sharp or constant. Does it come and go?
4. How long does pain last for?
5. Is pain accompanied by any other symptoms?
6. Does pain occur when you are active, and if so, which activities make it worse?
7. Do you take medications to make it better, if so, which ones and how often?
8. Do the medications help?
9. Are you taking any other remedies, including over the counter pills, food supplements or vitamins?
10. Have you seen another doctor about this condition and what was their opinion?
11. Do you think stress or worries may trigger the pain?
How Is It Treated?
The treatment for chest pain will depend on the underlying cause of pain. For example antibiotics may be prescribed for chest pain related to pneumonia and surgery such as coronary angioplasty may be needed for certain types of CHD.